Target lesion revascularization after wingspan: assessment of safety and durability.
OBJECTIVE
In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment.


METHODS
Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss.


RESULTS
To date, 36 patients in the registry have experienced ISR after percutaneous transluminal angioplasty and stenting with Wingspan. Of these patients, 29 (80.6%) have undergone TLR with either angioplasty alone (n=26) or angioplasty with restenting (n=3). Restenting was performed for in-stent dissections that occurred after the initial angioplasty. Of the 29 patients undergoing TLR, 9 required >/=1 interventions for recurrent ISR, for a total of 42 interventions. One major complication, a postprocedural reperfusion hemorrhage, was encountered in the periprocedural period (2.4% per procedure; 3.5% per patient). Angiographic follow-up is available for 22 of 29 patients after TLR. Eleven of 22 (50%) demonstrated recurrent ISR at follow-up angiography. Nine patients have undergone multiple retreatments (2 retreatments, n=6; 3 retreatments, n=2; 4 retreatments, n=1) for recurrent ISR. Nine of 11 recurrent ISR lesions were located within the anterior circulation. The mean age for patients with recurrent anterior circulation ISR was 57.9 years (vs 81 years for posterior circulation ISR).


CONCLUSIONS
TLR can be performed for the treatment of intracranial Wingspan ISR with a relatively high degree of safety. However, the TLR results are not durable in approximately 50% of patients, and multiple revascularization procedures may be required in this subgroup.
Fiorella
David J
DJ
Barrow Neurosurgical Associates, Ltd, Phoenix-Main Office, 2910 N. 3 Avenue, Phoenix, AZ 85013, USA. david.fiorella@bnaneuro.net
Levy
Elad I
EI
Turk
Aquilla S
AS
Albuquerque
Felipe C
FC
Pride
G Lee
GL
Woo
Henry H
HH
Welch
Babu G
BG
Niemann
David B
DB
Purdy
Phillip D
PD
Aagaard-Kienitz
Beverly
B
Rasmussen
Peter A
PA
Hopkins
L Nelson
LN
Masaryk
Thomas J
TJ
McDougall
Cameron G
CG
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004869:Equipment Safety / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome